Early Experience with a Stapled TransAnal Rectal Resection for Obstructed Defecation Syndrome

PURPOSE: This study was designed to assess the early outcome of a stapled transanal rectal resection (STARR) in obstructed defecation syndrome (ODS) patients with rectocele and rectal intussusception. METHODS: From January to December in 2005, 41 patients with the symptoms of obstructed defecation and the findings of rectocele and rectal intussusception in defecography, who failed in conservative management, were enrolled in this study. All patients underwent the STARR procedure. Preoperatively all patients received colonoscopy, a colon transit time test, cinedefecography, etc. The constipation score was evaluated by using the Cleveland Clinic Florida (CCF) constipation score preoperatively and at 1 month and 3 months after operation. RESULTS: The mean age of the patients was 55.3 (19~76) years. There were three males and thirty-eight females. The mean operation time was 39.3 (25~80) minutes, and the mean hospital stay was 4.2 (4~6) days. Complications were fecal urgency in 9 cases (21.9%), which improved after 3 months, bleeding in 5 cases (12.2%), and anastomotic stenosis in 1 case (2.4%). At postoperative defecography, both intussusception and rectocele had disappeared in most patients. All constipation symptoms were significantly improved (P < 0.01). The mean CCF constipation score was 17.6 (11~24) preoperatively, and improved to 9.1 after 1 month and 8.2 after 3 months (P < 0.01). The overall patient satisfaction was graded as excellent, good, fairly good and poor in 19 cases (46.3%), 13 cases (31.7%), 4 cases (9.7%), and 5 cases (12.2%), respectively. CONCLUSION: The STARR procedure seems to be a safe and effective procedure in ODS patients with rectocele and rectal intussusception. However, further study of the long-term results is required.

A Case of Hemorrhage from a Diverticulum of the Appendix

Diverticulum of the vermiform appendix is infrequently encountered, and in the absence of inflammation, it has been reported to be asymptomatic. Furthermore, hemorrhage from an appendiceal diverticulum is extremely rare, and has not yet reported in our country. We report a case of hemorrhage occurring in appendiceal diverticulum.

Risk Factors Affecting Lymph Node Metastasis and Recurrence in Early Gastric Cancer

PURPOSE: The prognosis of operated early gastric cancer is quite excellent and the 5-year survival rate shows to be over 90%. The less extensive treatment has been considered to be attractive. However, lymph node metastasis remains a main risk factor for recurrence of early gastric cancer. The author performed this study in order to determine which clinicopathologic factors of early gastric cancer influence lymph node metastasis and recurrence. MATENRIALS AND METHODS: A retrospective study was conducted on 222 patients with early gastric cancer who had been treated by gastrectomy combined with D2 or more extended lymph node dissection between January 1991 and December 1997 at the Department of Surgery, Kyunghee University Hospital. RESULTS: Lymph node metastasis was observed in 26 patients (11.7%), and the depth of tumor invasion and tumor size among clinicopathologic factors affected lymph node metastasis. The 5-year recurrence rate was 4.4%, and it was revealed that lymph node metastasis and depth of tumor invasion had a greater effect on recurrence than other clinicopathologic factors. CONCLUSION: The high risk factors of early gastric cancer in recurrence were submucosal tumor invasion, tumor size more than 2 cm, and lymph node metastasis. Patients of early gastric cancer with such high risk factors should undergo radical gastric resection than limited surgery.

Preoperative Staging of Rectal Cancer by CT & MRI

Accurate staging of rectal cancer preoperatively is important to plan a proper treatment and to predict treatment results. For the preoperative staging of rectal cancer, computed tomography (CT), transrectal ultrasonography (TRUS), and magnetic resonance imaging (MRI) have been used, but the role of them remains controversial. This research was intended to compare and analyze the accuracy of CT and MRI in the preoperative staging of rectal cancer. METHODS: From January 1998 to June 1999, sixty patients were studied by CT and MRI before their operations for rectal cancer in our institution, but two patients with local excision were excluded in N-staging as objects. The patients who had preoperative irradiation were also excluded in this study. Preoperative staging with CT and MRI were conducted by one radiologist according to 1997's TNM classification based on AJCC. On the results of pathological findings after operation, preoperative staging with CT and MRI were classified into T-staging and N-staging. Accuracy and agreement rate between pathological staging and preoperative staging by CT and MRI were compared and analyzed by Kappa value. RESULTS: The accuracy of CT was 68 percent in T-staging, and 58 percent in N-staging, MRI showed accuracy of 82 percent in T-staging and 64 percent in N-staging. In the T-staging, the agreement rate between pathological staging and CT staging was 0.54 (95% confidence interval), while the agreement rate was 0.70 in MRI staging, resulting in a higher agreement rate with MRI than with CT. In the N-staging, the agreement rate between pathological staging and CT staging was 0.38, with a relatively lower agreement rate, while the agreement rate was 0.56 in MRI staging. In our study, MRI showed a higher agreement rate than CT. CONCLUSIONS: In the future, more research should be conducted, but it can be conclued that in preoperative staging for rectal cancer, MRI using body arrayed coil has a better accuracy than CT. Subsequently MRI staging should be considered as a more useful investigation method before operation than CT.

A Case of Benign Fibrous Histiocytoma of the Mastoid Antrum / 대한이비인후과학회지

A benign fibrous histiocytoma is a tumor with 6brohlastic and histiocytic differentiation, most commonly found in soft tissues or adult bones. Its occurrence in the ear is, however, extremely rare, and there hasn't been any report on the case originating from the middle ear. We experienced a case of 37-year old male patient who complained of intermittent otorrhea and hearing loss. The patient had an 1 x 1 cm-sized mass in the right mastoid antrum in the temporal bone CT. Under the impression of cholesteatoma or benign tumor, a mass removal was done. A histopathologic investigation of the resected tumor showed typical features of benign fibrous histiocytoma. We herein report along with a brief literature review a case of benign fibrous histiocytoma arising in the mastoid antrum.

A Clinical Study of Traumatic Tympanic Membrane Perforation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traumatic tympanic membrane (TM) perforatons are encountered relatively often in clinical practice. We carried out a retrospective study of TM perforation according to different injury types, age and sex distribution, and relationship between size of perforation, degree of hearing loss and duration of spontaneous healing. MATERIALS AND METHODS: A retrospective review was performed on 152 cases of traumatic TM perforation diagnosed in the emergency room from January, 1992 to December, 1997. RESULTS: There was follow up loss in 109 out of 152 cases. Its incidence was predominant in males, acounting for the ratio of male to female being about 2:1. Injury to the left side was predominant, there being 112 cases (79%), compared to 40 cases (31%) to the right side. Perforation of Grade I was most common, with 86 cases (57%). Among them, with 54 cases (35.5%), antero-inferior perforation constituted about one third of all cases. The mean air-conduction difference was 14.7dB, and showed a tendency to increase as the size of perforation increased. Spontaneous healing rate was 76%, and the mean duration for complete healing was 22.1 days. There was also a tendency for the duration of healing to increase as the size of perforation increased. In the case of complication with otorrhea, there was a tendency for the duration of healing to be shorter. CONCLUSION: Although traumatic TM perforations have good prognosis, it is necessary to induce patients with profuse explanations for possible complications to visit the out-patient clinic until the wound has healed completely.